Provider Demographics
NPI:1558415257
Name:PIESZAK, CAROLINE C (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:C
Last Name:PIESZAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:C
Other - Last Name:PIESZAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD INC
Mailing Address - Street 1:1220 LA VENTA DR
Mailing Address - Street 2:#105
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3703
Mailing Address - Country:US
Mailing Address - Phone:805-777-7242
Mailing Address - Fax:805-777-7244
Practice Address - Street 1:1220 LA VENTA DR
Practice Address - Street 2:#105
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3703
Practice Address - Country:US
Practice Address - Phone:805-777-7242
Practice Address - Fax:805-777-7244
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770532827OtherFEDERAL TAX ID
CA770532827OtherFEDERAL TAX ID
CAA64453Medicare PIN